Karadede Abdulaziz, Aydinalp Ozlem, Sucu Murat
Department of Cardiology, Faculty of Medicine, Dicle University, Turkey.
Int Heart J. 2005 Nov;46(6):961-73. doi: 10.1536/ihj.46.961.
The aim of this study was to investigate the correlation between ECG changes prior to discharge and findings of early low dose dobutamine stress echocardiography (LDSE) performed in 6 +/- 2 days, in patients experiencing their first acute anterior MI. A total of 62 patients admitted with their first acute anterior MI were divided into three groups according to the findings of electrocardiograms performed on the 7-10th days: group A, isoelectric ST and negative or positive T wave; group B, ST elevation (> 0.1 mV) and negative T wave; and group C, ST elevation and positive T wave. There were no significant differences between the groups with respect to thrombolytic therapy and reperfusion criteria. In addition, 90% of the patients in group A (20/22), 66% in group B (12/18, P < 0.05 versus group A), and only 54% in group C (12/22, P < 0.01 versus group A) responded to LDSE. The infarct zone wall motion score index (WMSI) measured by LDSE was significantly decreased in group A compared to basal values (from 2.71 +/- 0.65 to 2.07 +/- 0.71 P = 0.02), and it was significantly different compared to groups B and C. Moreover, the serum creatinine kinase level of the patients in group C was higher (P < 0.01 versus group A), whereas the ejection fraction was inferior (group A 48%, group B 47%, and group C 41%, P = 0.04 versus group A). When the correlations between good left ventricular function and terminal QRS distortion, sum ST elevation, the number of leads with ST elevation, ST elevation shape on admission, and ST and T alterations in ECG at discharge were investigated, an independent correlation was found between ST and T alteration in ECG and a WMSI value < 2 at rest or after LDSE (P = 0.03, OR 3.08, 95%CI 1.05-8.98). At the infarct zone of patients with ST elevation and positive T waves, left ventricular function is worse and the viability is less. This simple classification may be useful in predicting left ventricular function at the time of discharge.
本研究旨在探讨首次发生急性前壁心肌梗死的患者出院前心电图变化与6±2天内行早期小剂量多巴酚丁胺负荷超声心动图（LDSE）检查结果之间的相关性。共有62例首次因急性前壁心肌梗死入院的患者，根据第7 - 10天的心电图检查结果分为三组：A组，ST段等电位线且T波阴性或阳性；B组，ST段抬高（>0.1 mV）且T波阴性；C组，ST段抬高且T波阳性。三组在溶栓治疗和再灌注标准方面无显著差异。此外，A组90%的患者（20/22）、B组66%的患者（12/18，与A组相比P<0.05）以及C组仅54%的患者（12/22，与A组相比P<0.01）对LDSE有反应。与基础值相比，A组经LDSE测量的梗死区域室壁运动评分指数（WMSI）显著降低（从2.71±0.65降至2.07±0.71，P = 0.02），且与B组和C组有显著差异。此外，C组患者的血清肌酐激酶水平较高（与A组相比P<0.01），而射血分数较低（A组48%，B组47%，C组41%，与A组相比P = 0.04）。当研究左心室功能良好与终末QRS波畸形、ST段抬高总和、ST段抬高导联数、入院时ST段抬高形态以及出院时心电图ST段和T波改变之间的相关性时，发现心电图ST段和T波改变与静息或LDSE后WMSI值<2之间存在独立相关性（P = 0.03，OR 3.08，95%CI 1.05 - 8.98）。在ST段抬高且T波阳性的患者梗死区域，左心室功能较差且存活能力较低。这种简单的分类可能有助于预测出院时的左心室功能。
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